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The Affordable Care Act in Paid Search Advertising -- A Retrospective

With the potential repeal of the Affordable Care Act on the horizon, January 31st marked the end of what may be the final open enrollment period for the ACA, popularly known as Obamacare. To evaluate the role of paid search advertising in the ACA, AdGooroo examined U.S. Google desktop text ad activity on 25 Affordable Care Act-related keywords from January 2014, when the new health insurance exchanges launched, though January 2017.

During this time, 2,884 advertisers spent $46.6 million sponsoring the 25 ACA keywords. The following chart ranks the top advertisers among them by paid search spend on the keyword group:
Interestingly, there were only two official government sites in the ranking where consumers could enroll for coverage under the ACA. The federal government site healthcare.gov ranked 7th with $1.4 million in spend on the keyword group during the 37-month period, while California’s health benefit exchange site coveredca.com ranked 20th with $530,000 in spend.

Otherwise, the ranking is predominantly comprised of lead aggregator sites—private companies with official-sounding URL addresses, which do not actually sell insurance but instead collect contact information from consumers seeking health insurance quotes and sell that data to various insurance agencies and providers. Lead aggregators made up the top five advertisers during the period: healthplans.com ($4.1 million spent), affordable-health-insurance-plans.org ($3.2 million), healthcare.com ($2.7 million), obamacareplans.com ($2.6 million) and obamacareusa.org ($2.5 million). There were nine other lead aggregator sites in the ranking.

The remaining positions in the top 20 ranking belonged to health insurance provider the Anthem Blue Cross Blue Shield site anthem.com, and to three nonprofit advocacy sites, transamericacenterforhealthstudies.org ($760,000), apha.org ($600,000), and democratichub.com ($580,000).

The last time we looked at ACA advertising in paid search back in November 2013—before the exchanges launched—seven of the top ten advertisers were from nonprofit groups seeking to influence public opinion. Only two lead aggregator sites appeared in the top 10.

What's in a Name?

Early on in the debate over the Affordable Care Act, the term ‘Obamacare’ was often used as a pejorative by opponents of the law. Eventually, it was embraced by the law’s proponents and has since become a mainstream term without any connotation, pro or negative. In fact, if paid search advertising is any indicator, ‘Obamacare’ would seem to be the de facto name of the law in the minds of the public rather than the Affordable Care Act.

From January 2014 through January 2017, the top ACA-related keyword was ‘obamacare’, which generated more than $25 million in paid search ad spend—or 54% of total money spent on the entire keyword group during the period. Ads served on the term also garnered nearly 261 million desktop search consumer impressions. The second-ranked keyword was the variation ‘obama care’, with $9.3 million in spend and 82 million consumer impressions, followed by ‘affordable care act’ with $8.8 million in spend and 83 million impressions. Spend on the remaining terms in the top ten drops precipitously to between just $139,000 and $21,000 per keyword.

The Importance of Keyword Selection

Underscoring the importance of keyword selection, we found a total of 425 advertisers sponsored the term ‘affordable care act insurance’ during the 37-month period—more than any other term in the top ten. Yet, ‘affordable care act insurance’ was far from the most popular term, generating only around $68,000 in spend and 270,000 impressions. For comparison, 244 advertisers sponsored ‘obamacare’ during the period, with its $25 million in ad spend and 261 million consumer impressions.

Assuming for the sake of argument that there was full overlap between the two terms, i.e., that every advertiser who sponsored ‘affordable care act insurance’ also sponsored ‘obamacare’, that would leave some 181 ACA advertisers who did not sponsor the term ‘obamacare’ at all and missed out on a sizeable opportunity to drive impressions and traffic to their site.